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March 26, 1997, Vol 277, No. 12 >
ARTICLE | March 26, 1997

A 96-Year-Old Woman With Insomnia FREE

Wallace Mendelson, MD
[+] Author Affiliations

Dr Mendelson is Professor of Psychiatry and Medicine, and Director of the Sleep Research Laboratory, University of Chicago, Chicago, Ill.

Dr Mendelson serves as a consultant for Bristol-Myers Squibb, Searle, and The Upjohn Co, and as a speaker for Wyeth-Ayerst.

This conference took place at the Medicine Grand Rounds of the Beth Israel Deaconess Medical Center, West Campus, Boston, Mass, on November 19, 1996.

Reprints: Erin E. Hartman, MS, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, East Campus, 330 Brookline Ave, LY339, Boston, MA 02215.

Clinical Crossroads at Beth Israel Deaconess Medical Center is produced and edited by Thomas L. Delbanco, MD, and Jennifer Daley, MD; Erin E. Hartman, MS, is managing editor. Clinical Crossroads section editor: Margaret A. Winker, MD, Senior Editor, JAMA.


JAMA. 1997;277(12):990-996. doi:10.1001/jama.1997.03540360058032
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References

Dr Delbanco:  Mrs G is a 96-year-old widow who has had trouble sleeping for the past 30 years. She has lived in a long-term care facility for the past 3 years, where she was admitted due to increasing physical disability and falls. She has 1 son with chronic depression with whom she has minimal contact. Her insurance is through Medicare and a supplemental commercial insurance program.Mrs G began to have difficulty falling asleep at the age of 65 years. At that time, and over the next 30 years, she took acetaminophen each evening, which she claims helped her go to sleep. When she developed sciatica 3 years ago, she had more trouble with sleeping and began taking oxazepam irregularly. She started to take it regularly 1 year ago when, in addition to her physical discomfort, she was disturbed by her cognitively impaired roommate in the nursing home.Mrs G

REFERENCES

1 +
Feinberg I, Koresko RL, Heller N.  EEG sleep patterns as a function of normal and pathological aging in man . J Psychiatr Res . 1968;;5:107-144.
2 +
Bliwise DL.  Normal aging . In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine . Philadelphia, Pa: WB Saunders Co; 1994;:26-39.
3 +
Feinberg I, Hibi S, Carlson VR.  Changes in EEG amplitude during sleep with age . In: Nandy K, Sherwin I, eds. The Aging Brain and Senile Dementia . New York, NY: Plenum; 1977;:5-98.
4 +
Rediehs MH, Reis JS, Creason NS.  Sleep in old age: focus on gender differences . Sleep . 1990;;13:410-424.
5 +
Bonnet MH, Rosa RR.  Sleep and performance in young adults and older normal and insomniacs during acute sleep loss and recovery . Biol Psychol . 1987;;25:153-172.
6 +
Gallup Organization. Sleep in America: 1991 . Princeton, NJ: The Gallup Organization; 1991;.
7 +
Gallup Organization. Sleep in America: 1995 . Princeton, NJ: The Gallup Organization; 1995;.
8 +
Mellinger GD, Balter MB, Uhlenhuth EH.  Insomnia and its treatment, prevalence and correlates . Arch Gen Psychiatry . 1985;;42:225-232.
9 +
Ford DE, Kamerow DB.  Epidemiologic study of sleep disturbances and psychiatric disorders . JAMA . 1989;;262:1479-1484.
10 +
Walsh JK, Hartman PG, Kowall JP.  Insomnia . In: Chokroverty S, ed. Sleep Disorders Medicine: Basic Science, Technical Considerations and Clinical Aspects . Boston, Mass: Butterworth-Heinemann; 1994;:219-239.
11 +
Johnson LC, Spinweber CL.  Quality of sleep and performance in the Navy . In: Guilleminault C, Lugaresi E, eds. Sleep/Wake Disorders: Natural History . New York, NY: Raven Press; 1983;:13-28.
12 +
Leigh JP.  Employee and job attributes as predictors of absenteeism in a national sample of workers . Soc Sci Med . 1991;;33:127-137.
13 +
Schweitzer PK, Engelhardt CL, Hilliker NA, Muehlbach MJ, Walsh JK.  Consequences of reported poor sleep . Sleep Res . 1992;;21:260.
14 +
Mendelson WB. Human Sleep: Research and Clinical Care . New York, NY: Plenum Press;1987;:323-342.
15 +
Mendelson WB.  Insomnia . In: Rakel RE, ed. Conn's Current Therapy . Philadelphia, Pa: WB Saunders Co; 1995;:33-35.
16 +
Resnick NM.  An 89-year-old woman with urinary incontinence . JAMA . 1996;;22:1832-1840.
17 +
Jain B, Mendelson WB.  Role of the primary care physician in the management of sleep disorders . Intern Med World Rep . 1996;;11:13-14.
18 +
Mendelson WB.  Drugs which alter sleep and sleep-related respiration . In: Kuna ST, et al, eds. Sleep and Respiration in Aging Adults . New York, NY; Elsevier Science Inc; 1991;:49-54.
19 +
Ancoli-Israel S, Kripke DF, Klauber MR, et al.  Sleep-disordered breathing in community dwelling elderly . Sleep . 1991;a;14:486-495.
20 +
Ancoli-Israel S, Kripke DF, Klauber MR, et al.  Morbidity, mortality and sleep-disordered breathing in community dwelling elderly . Sleep . 1996;;19:277-282.
21 +
Rajagopal K, Abbrecht PH, Derderian SS, et al.  Obstructive sleep apnea in hypothyroidism . Ann Intern Med . 1984;;104:491-494.
22 +
Grunstein RR, Sullivan CE.  Sleep apnea and hypothyroidism: mechanisms and management . Am J Med . 1988;;85:775-779.
23 +
Ancoli-Israel S, Kripke DF, Klauber MR, et al.  Periodic limb movements in sleep in community dwelling elderly . Sleep . 1991;b;14:496-500.
24 +
Mendelson WB.  Are periodic leg movements associated with clinical sleep disturbance? Sleep . 1996;;19:219-223.
25 +
Frederickson PA, Krueger BR.  Insomnia associated with specific polysomnographic findings . In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine . Philadelphia, Pa: WB Saunders Co; 1994;:523-534.
26 +
Terman M.  Light treatment . In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine . Philadelphia, Pa: WB Saunders Co; 1994;:1012-1029.
27 +
Stepanski EJ.  Behavioral therapy for insomnia . In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine . Philadelphia, Pa: WB Saunders Co; 1994;:535-541.
28 +
McClusky HY, Milby JB, Switzer PK, et al.  Efficacy of behavioral versus triazolam treatment in persistent sleep-onset insomnia . Am J Psychiatry . 1991;;148:121-126.
29 +
Milby JB, Williams V, Hall JN, et al.  Effectiveness of combined triazolam-behavioral therapy for primary insomnia . Am J Psychiatry . 1993;;150:1259-1260.
30 +
James SP, Mendelson WB, Sack DA, et al.  The effect of melatonin on normal sleep . Neuropsychopharmacology . 1987;;1:41-44.
31 +
James SP, Sack DA, Rosenthal NE, Mendelson WB.  Melatonin administration in insomnia . Neuropsychopharmacology . 1989;;3:19-23.
32 +
Zhdanova IV, Wurtman RJ, Lynch HL, et al.  Sleep-inducing effects of low doses of melatonin ingested in the evening . Clin Pharmacol Ther . 1995;;57:552-558.
33 +
Zhdanova IV, Wurtman RJ, Morabito C, et al.  Effects of low oral doses of melatonin given 2-4 hours before habitual bedtime on sleep in normal young humans . Sleep . 1996;;19:423-431.
34 +
Ferini-Strambi L, Zucconi ME.  Effects of melatonin on sleep microstructure: preliminary results in healthy subjects . Sleep . 1993;;16:744-747.
35 +
Ellis CM, Lemmens G, Parkes JD.  Melatonin and insomnia . J Sleep Res . 1996;;5:61-65.
36 +
Middelton BA, Stone BM, Arendt J.  Melatonin and fragmented sleep patterns . Lancet . 1996;;348:551-552.
37 +
 Overcoming insomnia . Consumer Rep . (March) 1997;;62(3):10-13.
38 +
Reppert SM, Weaver DW.  Melatonin madness . Cell . 1995;;83:1059-1062.
39 +
Turek FW.  Melatonin hype hard to swallow . Nature . 1996;;379:295-296.
40 +
Weekley LB.  Effects of melatonin on pulmonary and coronary vessels are exerted through perivascular nerves . Clin Autonomic Res . 1993;;3:45-47.
41 +
Vogel G, Scharf M, Walsh J, Roth T.  Effects of chronically administered zolpidem on the sleep of healthy insomniacs . Sleep Res . 1988;;17:80.
42 +
Scharf MB, Roth T, Vogel GW, Walsh JK.  A multicenter, placebo-controlled study evaluating zolpidem in the treatment of chronic insomnia . J Clin Psychiatry . 1994;;55:192-199.
43 +
Mendelson WB.  Subjective vs. objective tolerance during long term administration of triazolam . Clin Drug Invest . 1995;;10:276-279.
44 +
Schlich D, L'Heritier C, Coquelin JP, et al.  Long-term treatment of insomnia with zolpidem . J Intern Med Res . 1991;;19:271-279.
45 +
Horne JA, Shackell BS.  Slow wave sleep elevations after body heating: proximity to sleep and effects of aspirin . Sleep . 1987;;10:383-392.
46 +
King AC, Oman RF, Brassington GS, et al.  Moderate intensity exercise and self-rated quality of sleep in older adults . JAMA . 1997;;277:32-38.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Feinberg I, Koresko RL, Heller N.  EEG sleep patterns as a function of normal and pathological aging in man . J Psychiatr Res . 1968;;5:107-144.
2 +
Bliwise DL.  Normal aging . In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine . Philadelphia, Pa: WB Saunders Co; 1994;:26-39.
3 +
Feinberg I, Hibi S, Carlson VR.  Changes in EEG amplitude during sleep with age . In: Nandy K, Sherwin I, eds. The Aging Brain and Senile Dementia . New York, NY: Plenum; 1977;:5-98.
4 +
Rediehs MH, Reis JS, Creason NS.  Sleep in old age: focus on gender differences . Sleep . 1990;;13:410-424.
5 +
Bonnet MH, Rosa RR.  Sleep and performance in young adults and older normal and insomniacs during acute sleep loss and recovery . Biol Psychol . 1987;;25:153-172.
6 +
Gallup Organization. Sleep in America: 1991 . Princeton, NJ: The Gallup Organization; 1991;.
7 +
Gallup Organization. Sleep in America: 1995 . Princeton, NJ: The Gallup Organization; 1995;.
8 +
Mellinger GD, Balter MB, Uhlenhuth EH.  Insomnia and its treatment, prevalence and correlates . Arch Gen Psychiatry . 1985;;42:225-232.
9 +
Ford DE, Kamerow DB.  Epidemiologic study of sleep disturbances and psychiatric disorders . JAMA . 1989;;262:1479-1484.
10 +
Walsh JK, Hartman PG, Kowall JP.  Insomnia . In: Chokroverty S, ed. Sleep Disorders Medicine: Basic Science, Technical Considerations and Clinical Aspects . Boston, Mass: Butterworth-Heinemann; 1994;:219-239.
11 +
Johnson LC, Spinweber CL.  Quality of sleep and performance in the Navy . In: Guilleminault C, Lugaresi E, eds. Sleep/Wake Disorders: Natural History . New York, NY: Raven Press; 1983;:13-28.
12 +
Leigh JP.  Employee and job attributes as predictors of absenteeism in a national sample of workers . Soc Sci Med . 1991;;33:127-137.
13 +
Schweitzer PK, Engelhardt CL, Hilliker NA, Muehlbach MJ, Walsh JK.  Consequences of reported poor sleep . Sleep Res . 1992;;21:260.
14 +
Mendelson WB. Human Sleep: Research and Clinical Care . New York, NY: Plenum Press;1987;:323-342.
15 +
Mendelson WB.  Insomnia . In: Rakel RE, ed. Conn's Current Therapy . Philadelphia, Pa: WB Saunders Co; 1995;:33-35.
16 +
Resnick NM.  An 89-year-old woman with urinary incontinence . JAMA . 1996;;22:1832-1840.
17 +
Jain B, Mendelson WB.  Role of the primary care physician in the management of sleep disorders . Intern Med World Rep . 1996;;11:13-14.
18 +
Mendelson WB.  Drugs which alter sleep and sleep-related respiration . In: Kuna ST, et al, eds. Sleep and Respiration in Aging Adults . New York, NY; Elsevier Science Inc; 1991;:49-54.
19 +
Ancoli-Israel S, Kripke DF, Klauber MR, et al.  Sleep-disordered breathing in community dwelling elderly . Sleep . 1991;a;14:486-495.
20 +
Ancoli-Israel S, Kripke DF, Klauber MR, et al.  Morbidity, mortality and sleep-disordered breathing in community dwelling elderly . Sleep . 1996;;19:277-282.
21 +
Rajagopal K, Abbrecht PH, Derderian SS, et al.  Obstructive sleep apnea in hypothyroidism . Ann Intern Med . 1984;;104:491-494.
22 +
Grunstein RR, Sullivan CE.  Sleep apnea and hypothyroidism: mechanisms and management . Am J Med . 1988;;85:775-779.
23 +
Ancoli-Israel S, Kripke DF, Klauber MR, et al.  Periodic limb movements in sleep in community dwelling elderly . Sleep . 1991;b;14:496-500.
24 +
Mendelson WB.  Are periodic leg movements associated with clinical sleep disturbance? Sleep . 1996;;19:219-223.
25 +
Frederickson PA, Krueger BR.  Insomnia associated with specific polysomnographic findings . In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine . Philadelphia, Pa: WB Saunders Co; 1994;:523-534.
26 +
Terman M.  Light treatment . In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine . Philadelphia, Pa: WB Saunders Co; 1994;:1012-1029.
27 +
Stepanski EJ.  Behavioral therapy for insomnia . In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine . Philadelphia, Pa: WB Saunders Co; 1994;:535-541.
28 +
McClusky HY, Milby JB, Switzer PK, et al.  Efficacy of behavioral versus triazolam treatment in persistent sleep-onset insomnia . Am J Psychiatry . 1991;;148:121-126.
29 +
Milby JB, Williams V, Hall JN, et al.  Effectiveness of combined triazolam-behavioral therapy for primary insomnia . Am J Psychiatry . 1993;;150:1259-1260.
30 +
James SP, Mendelson WB, Sack DA, et al.  The effect of melatonin on normal sleep . Neuropsychopharmacology . 1987;;1:41-44.
31 +
James SP, Sack DA, Rosenthal NE, Mendelson WB.  Melatonin administration in insomnia . Neuropsychopharmacology . 1989;;3:19-23.
32 +
Zhdanova IV, Wurtman RJ, Lynch HL, et al.  Sleep-inducing effects of low doses of melatonin ingested in the evening . Clin Pharmacol Ther . 1995;;57:552-558.
33 +
Zhdanova IV, Wurtman RJ, Morabito C, et al.  Effects of low oral doses of melatonin given 2-4 hours before habitual bedtime on sleep in normal young humans . Sleep . 1996;;19:423-431.
34 +
Ferini-Strambi L, Zucconi ME.  Effects of melatonin on sleep microstructure: preliminary results in healthy subjects . Sleep . 1993;;16:744-747.
35 +
Ellis CM, Lemmens G, Parkes JD.  Melatonin and insomnia . J Sleep Res . 1996;;5:61-65.
36 +
Middelton BA, Stone BM, Arendt J.  Melatonin and fragmented sleep patterns . Lancet . 1996;;348:551-552.
37 +
 Overcoming insomnia . Consumer Rep . (March) 1997;;62(3):10-13.
38 +
Reppert SM, Weaver DW.  Melatonin madness . Cell . 1995;;83:1059-1062.
39 +
Turek FW.  Melatonin hype hard to swallow . Nature . 1996;;379:295-296.
40 +
Weekley LB.  Effects of melatonin on pulmonary and coronary vessels are exerted through perivascular nerves . Clin Autonomic Res . 1993;;3:45-47.
41 +
Vogel G, Scharf M, Walsh J, Roth T.  Effects of chronically administered zolpidem on the sleep of healthy insomniacs . Sleep Res . 1988;;17:80.
42 +
Scharf MB, Roth T, Vogel GW, Walsh JK.  A multicenter, placebo-controlled study evaluating zolpidem in the treatment of chronic insomnia . J Clin Psychiatry . 1994;;55:192-199.
43 +
Mendelson WB.  Subjective vs. objective tolerance during long term administration of triazolam . Clin Drug Invest . 1995;;10:276-279.
44 +
Schlich D, L'Heritier C, Coquelin JP, et al.  Long-term treatment of insomnia with zolpidem . J Intern Med Res . 1991;;19:271-279.
45 +
Horne JA, Shackell BS.  Slow wave sleep elevations after body heating: proximity to sleep and effects of aspirin . Sleep . 1987;;10:383-392.
46 +
King AC, Oman RF, Brassington GS, et al.  Moderate intensity exercise and self-rated quality of sleep in older adults . JAMA . 1997;;277:32-38.

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